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"You Never Think It Will Happen to You": Health Workers Confront the Risks of Tuberculosis

Patricia Bond was working as a nurse at a health facility in South Africa when she developed some troubling symptoms. Eventually she was diagnosed with multidrug-resistant tuberculosis (MDR-TB), a dangerous form of the disease that doesn’t respond to the usual medications and is notoriously difficult to treat.

“You hear of TB,” Patricia says, “but you never think it will happen to you.”

In South Africa, one epidemic has fuelled another—HIV has sent TB rates soaring. The country now has the third-highest incidence of TB in the world, behind only India and China1. And just by going to work every day, health workers like Patricia face major risk of exposure.

Today, Patricia is lucky to be alive. The disease and treatment robbed her of her hearing and the occupation she loved—she’s no longer able to provide care for patients. But she is able to help prevent what happened to her from happening to other health workers.

Patricia and her colleagues Dr. Bart Willems and Dr. Arne von Delft—all TB survivors—are members of an advocacy team called TB Proof, and they’re in the US to educate Americans about the risks that all health workers face on the job. Many people in developed countries don’t think much about TB at home, but TB Proof urges worldwide preventive action now before strains of MDR-TB spread more widely.

“There’s a fixed false belief that we aren’t at risk,” Bart told me when I talked with the team members in Washington, DC, this week. He’s a resident in public health medicine at Stellenbosch University. “It won’t happen to health workers—that’s the institutional message currently conveyed.”

He explains that health facilities in South Africa typically don’t educate staff about the risks of TB or how to take precautions. And many health workers who do get TB are ashamed. “Health care workers don’t report it because they think it’s abnormal [for them to get it],” Bart noted. They’re often treated in private clinics so their colleagues won’t find out. As a result, he says, “we don’t have a grip on how many health workers have TB.”

But the secrecy and lack of education can make it more difficult to prevent and contain infections and increase the risk for everyone. “Think about this as something like the Taliban becoming strong [in one country],” says team member Arne. “If you don’t deal with it, that risk will cross borders.”

In South Africa, TB Proof is trying to reduce stigma and educate the health community. But this hasn’t been easy. “We’re meeting with a lot of resistance,” Arne shares.

“Real doctors won’t get TB—that’s what the message has been,” Bart says. “But we’re acting with the new generation to be agents of change. Anyone can get TB. Raising awareness in health workers of the risk will help, and then hopefully they can protect themselves.”

These health workers’ personal stories reminded me once more of how crucial it is to keep providers safe on the job. As a colleague once said: Saving lives shouldn’t mean you risk your own. IntraHealth vigorously defends the rights of health workers to be protected from infection and other occupational hazards. All health workers are entitled to safe workplaces where they are treated with dignity—and our health workers must be protected.

This short brief from the IntraHealth-led CapacityPlus project includes practical advice for making health workers’ environments safer. TB Proof’s website and Facebook page contain further information about the specific risks of tuberculosis and how to stay healthy. And don’t forget to check out events marking World TB Day to learn more.